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Medicare Physician Fee Schedule, QPP Rule Finalized for 2022

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Top ACP priorities implemented, including policies on critical care services reimbursement, MVP options and telehealth

Nov 19, 2021 (ACP) – The Centers for Medicare & Medicaid Services has finalized the 2022 Medicare Physician Fee Schedule and Quality Payment Program rule. The American College of Physicians is pleased to report that several of its top priorities have been implemented.

“CMS has taken a big step toward better recognizing the value of critical care services performed by internal medicine physicians and appropriately reimbursing those who perform these services,” said Dejaih Johnson, an ACP associate for regulatory affairs. “Internal medicine specialists and other frontline physicians have been disproportionately impacted by the ongoing COVID-19 pandemic. We advocated to ensure that physicians across the country will be able to provide care that improves health and be properly reimbursed for the valuable work they do.”

One of the top ACP priorities was to push for CMS to revise proposed provisions regarding reimbursement in two crucial areas. “We are extremely happy to see that CMS listened to the feedback that we gave them and changed their position,” Johnson said. “The new rules allow critical care services to be paid on the same day as other evaluation and management (E/M) services and provide separate reimbursement for critical care services in addition to a procedure with a global surgical period.”

According to Johnson, “these policies are important because patients who are critically ill or injured require complex care that is often extremely difficult to manage and time-consuming. These changes will allow for clinician work to be appropriately paid as a separate service and are a step in the right direction toward adequately recognizing the value of these services.”

ACP is also pleased that CMS updated pricing for clinical labor for the first time since 2002. “Over the years, ACP and other stakeholders have raised concerns that the long delay created a significant disparity between CMS clinical wage data and the market average for clinical labor,” Johnson said. “Since these rates have not been routinely updated, clinical labor was at risk of becoming undervalued over time relative to equipment and supplies, for example, which have been updated.”

ACP appreciates that CMS has finalized that it will retain all services previously added to the Medicare telehealth services list on a temporary basis through the end of 2023. “Beyond the public health emergency, CMS will implement the telehealth provisions in the Consolidated Appropriations Act of 2021, which include: removing geographic restrictions for telehealth services provided to diagnose, evaluate or treat a mental health disorder and adding the patient's home as a permissible originating site for mental health services,” Johnson said.

CMS will also cover audio-only telehealth services for diagnosis, evaluation or treatment of a mental health disorder. “ACP was happy to see these increased flexibilities,” Johnson said, “but we remain disappointed that E/M services were not included and believe these flexibilities should be broadened to include services beyond mental health.”

Another positive change includes the adjusted Quality Payment Program MIPS Value Pathway options for 2023. They will include four different pathways that are relevant to internal medicine specialists.

“One of the included pathways, Optimizing Chronic Disease Management, is similar to a pathway that ACP previously submitted to CMS for consideration,” Johnson said. “In conversations with top CMS officials, the College continues to advocate that the agency create synergy across the performance categories and stop thinking of each category as siloed. We're urging them to look for opportunities to leverage existing data to satisfy requirements for multiple categories when relevant and appropriate.”

ACP still has more work to do on the physician reimbursement front. “In its final rule, CMS does not have the authority to finalize the specific actions to mitigate the payment cuts set to return on Jan. 1, 2022,” Johnson said. “The 2022 conversion factor is set at $33.59, which represents a nearly 4 percent decrease from the $34.89 conversion factor for 2021 and a nearly 7 percent decrease from the 2020 conversion factor.”

ACP has ongoing advocacy efforts with Congress to address cuts that can be directly attributed to the budget neutrality mandate, sequestration cuts and other policies.

“We continue to urge Congress to act before the end of the year,” Johnson said. “The College recommends that clinicians be prepared for the cuts to go into effect if Congress does not pass a legislative fix to preserve payment increase for E/M services.”

ACP is also troubled by the finalized policy for “split” or “shared” E/M visits. As Johnson explained, for 2022, CMS will define split or shared E/M visits as those provided in the facility setting by a clinician and a nonphysician practitioner in the same group. The clinician who conducts more than half the visit -- or the “substantive portion” of the visit -- would bill for it.

For 2023, she said, the “substantive portion” will be defined as more than half of the total time spent. But for 2022, it can be history, physical exam or more than half of the total time. “ACP is concerned that CMS has not recognized the importance of physicians having one consistent set of guidelines in reporting their services and has further complicated medical record documentation for these visits,” Johnson said. “CMS has finalized that a modifier is required on the claim to identify these services, which is inconsistent and contrary to the purpose of the new E/M code structure -- alleviating burden. In a time when physicians are undervalued and overworked, this policy will do nothing more than increase administrative burden and lend to physician burnout.”

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Back to the November 19, 2021 issue of ACP Advocate